- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,938.87 / $2,439.35 / $2,631.87
| Professional | | $1,938.87 | $2,439.35 | $2,631.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,274.02 / $8,473.90 / $10,032.10
| Facility | | $6,274.02 | $8,473.90 | $10,032.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,332.04 / $2,332.04 / $3,900.17
| Professional | | $2,332.04 | $2,332.04 | $3,900.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,941.06 / $2,941.06 / $2,941.06
| Facility | | $2,941.06 | $2,941.06 | $2,941.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,146.96 / $2,146.96 / $2,146.96
| Professional | | $2,146.96 | $2,146.96 | $2,146.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,000.89 / $2,701.65 / $3,689.72
| Professional | | $2,000.89 | $2,701.65 | $3,689.72 |